Sleep debt = slow death

Sleep that knits up the ravelled sleeve of care/ The death of each day’s life, sore labour’s bath/ Balm of hurt minds, great nature’s second course,/ Chief nourisher in life’s feast.
— Macbeth, Willam Shakespeare

Ashok Chhabria lives by the credo ‘work is worship’. The 46-year-old corporate consultant had little time for anything else till last year. His job, which entails a lot of research, necessitates at least 15 days of travel every month. But besides that, there is very little movement. Chhabria had always been overweight and in the last five to six years, he had developed high blood pressure. In 2011, however, Chhabria began experiencing some rapid physical changes. He suddenly began to pile on weight, very quickly. His thighs swelled up, he had difficulty walking and would often run out of breath while doing so. He was also unable to fall asleep at night.

“Initially, I thought it had something to do with my weight and blood pressure. I finally decided to consult a doctor and after running some tests, he told me that I had an enlarged heart that was being caused by a sleep disorder,” he says.

Health takes a beating
Chhabria’s complications may have been caused by an extreme case of sleep disorder, but you cannot afford to brush them aside. In a society that values productivity more than rest, sleep has become a dirty word. ‘I’ll sleep when I’m dead’ seems to be every model urban citizen’s motto. But more and more studies from across the world are reaching a rather scary conclusion: if you don’t sleep enough, you may well be hastening the process of health impairment, thereby inviting an untimely death.

Take, for example, the study conducted on the health of sleep-deprived people by the Seoul National University College of Medicine this year. “Adolescents with behaviourally induced insufficient sleep syndrome had higher suicide ideation (thoughts of suicide) scores than those who slept for seven or more hours on weekdays,” it concludes.

Another study conducted by the National Center for Chronic Disease Prevention and Health Promotion in the US states that sleep apnea — a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep - is associated with probable major depression in a national sample of adults.

Closer home, there have been a couple of recent reports which shed light on sleep disorders rampant in urban India and their consequences. A recent survey by The Associated Chambers of Commerce and Industry of India (ASSOCHAM) showed that 78% of corporate employees in India sleep for less than six hours a day. Needless to say, they suffer from numerous sleep disorders. Mumbai, according to the survey, is the second most afflicted city — right after Delhi.

In Mumbai, Dr Pramod Sanghi, a senior consultant at the Asian Heart Institute, conducted a study on the circadian pattern of mice. He managed to genetically engineer the mice to not have the clock gene (which regulates and puts in to effect the 24-hour sleep cycle of most mammals). The erratic sleep pattern that followed resulted in increased heart rates and blood pressure in the mice.

Through further tests and measurements, Dr Sanghi managed to determine that the mice with erratic sleep patterns faced a 48% higher risk of a heart attack than those with normal sleep.

Extrapolating the findings to humans, he concluded that those of us who do not get seven to nine hours of sleep every day run the same increased risk of a heart attack.

“Lack of sleep or even irregular interrupted sleep, which happens when you have obstructive sleep apnea, causes the body to produce a high level of adrenaline. This extra adrenaline in the blood causes the heart to enlarge, impairing its squeezing function. If left untreated, it can cause a heart attack,” warns Dr Sanghi.

Diagnosing the problem
But, how does one safely conclude that he/she is suffering from a sleep disorder? That’s where a sleep clinic helps. Chhabria went to one such clinic, where he was asked to wear an oxygen mask while sleeping. “I was hesitant at first. I couldn’t believe that the lack of sleep could cause heart problems,” he says.

Thankfully, Chhabria listened to his doctors and tried out the oxygen mask therapy. After a few months, Chhabria confesses, he felt like a new man. “I had grown irritable and depressed with my condition. It was a nightmare for me. When my sleeping pattern finally became regular, it was such a relief. I wouldn’t get breathless any more. In the mornings I was full of energy. I was back to my old self again,” he gushes.

Dr Srikant Kondapaneni, a New York-based sleep scientist, explains how a sleep clinic helps diagnose disorders. “The way to diagnose is by performing a sleep study, which entails a person coming into an outpatient sleep lab at night (usually around 9pm), sleeping there and leaving around 6-7am the next day.”

At his clinic, Dr Kondapaneni says, a patient is fitted with EEG monitoring equipment, which allows the doctors to read the brainwaves so that they can see exactly when he/she fall asleep, what stages of sleep he/she is in and how frequently he/she wakes up. A patient is also fitted with some equipment on the chest and nose so that doctors can monitor every single breath during the night. By monitoring brainwaves and the breathing pattern, doctors can conclude if a patient faces any instance of sleep apnea. 

Mind games
A fitful sleep pattern may also cause psychological harm. Sleep-related mental distress, in fact, can be far more insidious because it’s not something that can be easily diagnosed. “Lack of proper sleep patterns can lead to depression, anxiety and other psychological problems. Modern lifestyle trends among the urban youth, which include enormous amounts of visual stimuli provided by TV, video games, computers and smart phones, often late into the night, leaves their brain in an excited condition and unable to sleep. This is causing a variety of mental problems and is exacerbating existing problems,” says Dr Kersi Chavda, consultant psychiatrist at the PD Hinduja Hospital. 

Siddhart Chander is too familiar with the psychological implications. A 28-year-old advertising executive, Chander was diagnosed with bi-polar disorder five years ago. “Just before I was diagnosed, for about a month-and-a-half, I didn’t sleep very much. I used to go without sleep for three days at a stretch, and on other days, I probably only slept for a couple of hours. This lack of sleep proved to be the first symptom of my bi-polarity,” he recalls.

“When I would lie awake at night, my mind would begin to morph. It would start going on a rapid upswing. I would feel like an extrovert, expansive, invincible. I would stop believing that the rules of society applied to me. I have picked up the phone at 3am and called people without any consideration,” says Chander. Even though his bi-polarity was not caused by a sleep disorder, it aggravated the situation.”To date, my psychiatrist keeps a very close tab on how much I sleep. He has told me in no uncertain terms that sleeping for less than seven hours a day could very well cause me to go manic.”

Robert Frost, the erstwhile US Poet Laureate, once wrote, “The woods are lovely, dark and deep/ But I have promises to keep/ And miles to go before I sleep/ And miles to go before I sleep.”
In the battle of the contradictory sentiments expressed by these two literary giants, experts would prefer if you heeded Shakespeare’s words more than Frost’s.